Reprinted with permission from ImplantInfo.com. Check it out for tons of before and after pics and more questions and answers!

Currently, many women who engage in bodybuilding and fitness activities are seeking breast augmentation.
One of the down-sides of bodybuilding, in fact, is the gradual loss of breast tissue with increased lean
body mass and decreased body fat. Just what you wanted to hear, right!? But never fear. If you've lost
your girlish curves as you've trained and toned, you can consider breast augmentation as a safe way to
restore some fullness to your figure. Most of the issues pertinent to all patients undergoing breast
augmentation remain pertinent to fitness fanatics. I hope to provide a little more information specific
to women who enjoy weight training and are considering breast implants.

Q. Should I have implants under the muscle or over the muscle?

A. Many women who bodybuild are worried about the impact of lifting on the implant if it's under the
muscle. Will it move? Will it deflate or pop? Obviously these things can happen, but it is not typical.
In general, I recommend placement of implants under the pectoralis muscle, since the appearance of the
implant is better, especially in patients with very low body fat. In those patients, the implants tend
to be very obvious when placed over the muscle, including features such as rippling. By placing the
implant under the muscle, there is more tissue between the implant and the outside world, thus making
the implant less obvious.

The "ridges" on the insides of the breasts are an example of rippling.

Q. Will the implant under the muscle be squeezed by the muscle?

A. Well... yes, it will. But that's not necessarily a problem since the implants are made to stand up to
lots of abuse, such as a band of Miami Dolphin linebackers. The implants are compressible, and in many
cases you will be advised to massage the implants to keep them soft. The motion of the muscle will not
normally hurt the implant. On the other hand, the motion of the pectoralis muscle can cause "bouncing"
of the implant or flattening, when the muscle is flexed. This isn't a problem either. It's just
something that you should be aware of. I've seen a clever exotic dancer who used this ability in her
dancing routine. Rather remarkable.

Q. Is there some special technique which places the implant half under the muscle and half over the
muscle?

A. I have had patients tell me that their friend's plastic surgeon invented a technique like this, and I
thought to myself, "hmm... isn't that how we all do submuscular implants?" If you think of what a man's
chest looks like, the nipple is at the lower edge of the pectoralis muscle. The implants, when properly
positioned, are essentially centered under the nipple. That makes half of the implant under the
pectoralis muscle, but the lower half is not covered by the muscle. The lower half sits over the
serratus muscles on the side and the rectus abdominis muscle below. Those names probably mean something
to you if you're a bodybuilding enthusiast, but for everyone else, it's just important to know that the
lower part of the implant isn't under muscle, except in cases of breast reconstruction, which is very
different from cosmetic breast augmentation.

Under The Muscle

Partially Under The Muscle

Over The Muscle

Q. Which incision is best for my augmentation?

A. I generally use one of two incisions. Most frequently, I place the incision in the inframammary fold,
under the breast, since this is well hidden by the breast (which is now larger and covers the
incision!), and this incision is the easiest to use. It is one inch long, and it could actually be
slightly smaller, but I can't get my finger in a smaller incision. The other option which I use is a
"periareolar incision"
around the nipple. I use this incision when I plan to do a breast lift
(mastopexy) at the same time as the augmentation, and in that case, I do a periareolar (donut)
mastopexy, making an incision the whole way around the nipple, but no other incisions. This is important
for women who have sagging of the breast after child-bearing or weight loss. The incision which is
placed in the axilla (arm-pit) is another option, but I rarely use this incision for several reasons.
Primarily, many of my patients are very active fitness enthusiasts, and they often wear sleeveless
clothing, exposing the axilla. An incision there might be visible, whereas they are not going topless
very often, thus hiding an incision on or under the breast. Additionally, an axillary approach makes
management of the inframammary fold a little more difficult, especially in bodybuilding women, and this
could result in a high implant. I try to avoid this, and the other incisions make that easier. I have
not used the transumbilical approach in my practice (through the belly button), but this is obviously
another alternative, which is employed by a limited number of surgeons.

Q. Round implants or tear-drop (anatomic) implants?

A. Generally, I have used round implants for most patients. These are somewhat easier to use, and the
results are generally excellent. In a few patients, however, I have found that McGhan anatomic implants
may provide more projection and a larger implant with a narrower base. If a patient has a narrow rib
cage and wants a larger implant, this can be useful. Additionally, because competitive bodybuilding
women may want to be able to exhibit their intercostals and serratus (the muscles on the side), a larger
round implant may obscure that area, whereas the anatomic implant might not. This is less important with
a moderate sized implant, since the base width is narrower. As for the appearance of the augmented
breast with a round versus an anatomic implant, I have been fairly unimpressed by any differences with
regard to a "more natural appearance". Both give very good results when used properly.

Q. Smooth or textured?

A. With the round implants, I use a smooth implant, since it is a little softer and less palpable. The
anatomic implant is textured, so that it doesn't spin around once it is implanted. Obviously, an upside-
down anatomic implant might make you look top-heavy in a way you hadn't anticipated.

Q. Is the surgery painful?

A. Breast augmentation is perhaps the most painful operation I do in my practice. But 99.9% of women say
that they would do it again for the benefit they perceive afterwards. Sort of like child-bearing. The
pain is managed with pain relievers, and while you should keep it in mind, it should not be enough of a
reason for not having the surgery.

Q. Well, if it's so painful, will I ever be able to work out again?

A. Of course. In fact, I allow my patients to start cardio in about a week, and they can start lifting
with light weights after two weeks. I recommend that they don't do any chest exercises for up to six
weeks, generally cautioning that if it hurts, don't do it. In spite of this, most women who bench press
tell me that they are able to bench press the same weight as they did pre-operatively by eight to twelve
weeks post-operatively. In a number of my patients who are very serious about their training, they have
continued to increase their bench press strength as though they never had implants placed.

Many thanks to Dr. Rick Silverman from Boston, MA for putting together such a comprehensive summary of the issues bodybuilding
and fitness enthusiasts want to address when having a breast augmentation.